Fracture nail and director



March 1941- J. J. CALLAHAN EI'AL .419

FRACTURE NAIL AND DIRECTOR Filed March 18, 1938 2 Sheets-Sheet 1 March 18, 1941. J CALLAHAN L 2,235,419

FRACTURE NAIL AND DIRECTOR Filed March 18, 1938 2 Sheets-Sheet 2 CZzrZo jc'ud'eri ma! 3 I \fc'zmes JCaZZcz/zan Patented Mar. 18, 1941 PATENT OFFICE FRACTURE NAIL AND DIRECTOR James I. Callahan, Oak Park. and Carlo Scuderi, Chicago, Ill.

Application March is, 1938. Serial No. 196.582 1 Claim. (Cl. res-s3 The present invention relates to surgical instruments, and more particularly to an instrument designed to facilitate the repair of fractures of the neck of the femur. In fractures of this character it is desirable to rapidly connect the two ends of the fractured bone and hold them tightly together until they have knit sufficiently to retain their position. It has been proposed heretofore to drive a metal nail through the trochanteric bulge into and through the neck past the fracture to the head which is seated in the acetabulum. The present invention provides a simple flange which maybe driven into the bone to connect the parts together. In addition, the present invention provides a directing tool which acts to determine the length of flange needed to peg the head fragment accurately to the femur in each case. In addition, the director acts to keep the flange straight so that it must follow the course along which it was started until driven far enough in to lock the fractured parts together.

The invention contemplates the provision of a simple combination of flange, director and inserter by which the flanges can be readily applied and the length of flange quickly determined.

The features and advantages of the invention will appear more fully as the description proceeds, reference being had to the accompanying drawings, wherein a preferred form of the invention is shown. It is to be understood, however, that the description and drawings are lllustrative only, and are not to be considered as limiting the invention except insofar as it is limited by the claim.

In the drawings, Fig. 1 is a perspective view illustrating the application of the director to a fractured femur;

Fig. 2 is a view similar to Fig. 1 showing the second step in the procedure where the director is used to guide the starting chisel;

Fig. 3 illustrates the starting chisel at the limit of its depth;

Fig. 4 is a view similar to Fig. 1 showing the inserter applied and the flange partially driven in;

Fig. 5 shows the flange driven in completely;

Fig. 6 illustrates the application of a pulling tool for removing the flange;

Fig. 7 is a perspective view illustrating the use of the inserter in the final driving operation by which the flange is seated and the fractured parts are fixed together;

Fig. 8 is a perspective View of the director;

Fig. 9 is a sectional view taken on the line 8-8 of Fig. 8;

Fig. 10 is a perspective view of the flange used, and r Fig. 11 is an end view of the inserter illustrating the slot provided to receive a flange.

Referring now to the drawings, the present invention is embodied in an instrument which is composed substantially of four parts. The fracture nail which acts as the means for pegging the bond together comprises a flange l2, shown in perspective in Fig. 10. This flange is p'referably made of angular stainless steel. It is strong and sharply pointed at one end, as indicated at IS. The other end is provided with a plurality of apertures l4 and I5 which may be utilized to withdraw the flange when it becomes necessary to remove it. The flanges are made in various lengths so as to be adapted to different bone lengths. They are also made in wide and narrow widths so that where the neck of the femur is small a narrower width flange may be used, or for the average adult with normal thickness of the femoral neck the wide flange may be used.

The means for positioning and directing the flange comprises a director implement it. The director consists of a bar ll having 8. prong I8 at its tip which is adapted to be inserted in the anterior lip of the acetabulum. The bar ll has a driving head I9 at the end opposite the prong l8 and has a handle 20 by which it may be shifted by the operator. A bracket 2| is adapted to slide lengthwise of the bar ll and to be locked in position thereon by means of a set screw 22, as will be readily apparent. The director includes a directing block 23 which is carried by the bracket 2!. This directing block comprises a guide for the flange l2 consisting of a base made up of an outturned part 25 of the bracket 2i and a complementary part 25 attached to the bracket 2! by a screw 26 and a handle 21. The bracket 2! also has an edge portion 28 which cooperates with suitable markings indicated at 29 on the bar I! for measuring the required length of flange. A prong 30 is provided on the bracket 2! and is adapted to enter the trochanter of the femur when the prong i8 is inserted into the acetabulum, as previously described. The markings on the bar ll will indicate, when the director is in the position shown in Fig. 1, the size number of the proper flange which will be long enough to reach the head of the femur, yet not long enough to perforate the acetabulum. When it is desired to use the large, or wide,

type of flange, the director block made up of the parts 23 and 23 will be sufflcient. However, when a narrower flange is used, an adapter plate 3| having pins thereon may be placed in the directing block so as to hold the small flange and guide it correctly. The additional implements necessary are a starting chisel 32 (shown in Figs. 2 and 3). This starting chisel has an angle or tip 33 which is adapted to be driven through the hard cortical bone to avoid possibility of turning the edge of the flange when it is inserted.

The starting chisel is driven in such a distance as is indicated in Fig. 3 and is then removed to permit the application of the flange. The flange is driven in by the use of an inserter 34 which has a head 35 shaped to flt the trochanter at the point of insertion of the flange. This head 33 is provided with two intersecting grooves 33 and 31 which extend into the head far enough that the end of a flange will be covered down over the openings at H and I therein. The inserter prevents damage to the hammer end of the flange and facilitates driving the flange since it projects out from the wound.

The only additional implement that may be necessary is a pulling tool 38 which has a pin 39 thereon (see Fig. 6). The pin 39 is adapted to be inserted in one of the openings i4 and i5 for withdrawing a flange after it has been driven in. A head 40 is provided on the pulling tool 38 so that a hammer may be used thereon if necessary.

The several parts of the present instrument are made of suitable metal and preferably chromium plated so as to be free from corrosion and easily cleaned.

The procedure in using the instrument is briefly as follows: The prong it of the directing bar I! is inserted as shown in Fig. l, and the prong 30 of the bracket 21 is driven in. The set screw 22 can then be tightened to hold the bracket 2| in place. The director is now in position and the position of the edge 28 of the bracket will indicate the size number of the proper flange which will be long enough to reach the head of the femur, but not too long. The starting chisel 33 is next used, as is illustrated in Figs. 2 and 3, so as to avoid the possibility of turning the edge of the flange to be used. The proper size flange is next placed in the directing block and the inserter 33 is used to drive the flange in about 35 its length. When the flange is driven in 95 its length, it" can no longer swerve from its proper course. The director is then removed and the flange is driven in completely,

the head of the inserter preventing the holes in the end of the flange from being buried. A few mallet blows after the head of the inserter strikes the bone serve to impact the fractured surfaces.

From the above description it is believed that the construction and operation of this instrument will be readily apparent to those skilled in this art.

Having thus dacribed. our "invention, what we claim as new and desire to secure by Letters Patent is:

A fracture nail director comprising a pronged directing bar having a prong at one end thereof adapted to be inserted in the anterior lip of the acetabulum, a pronged directing block guided by said her, said block having a prong at one end adapted to be inserted in the trochanter of the femur, the prong on the bar being directed lengthwise of the bar, and the prong on the block being directed parallel to the bar, and means for flxing the block on the bar, the directing block having a guiding passage through which a tool such as a starting chisel or a fracture nail may be driven, said guiding passage being provided with walls directed angularly with respect to each other to receive and guide a fracture nail which is angular in cross section and an anchoring fracture nail angular in cross section adapted to be driven through said passage.

JAMES J. CALLAHAN. CARLO SCUDERI. 

